ANOTHER MICHAEL MOORE CONTROVERSY
Cuba's Health System Better Than US?
CUBA CONTROVERSY: Michael Moore's movie Sicko generates controversy over
Cuba segment.
Cuba experts disagree with information in Michael Moore's Sicko movie.
BY CHRONICLE STAFF
In Sicko, the new movie by controversial writer-director Michael Moore,
there is brief, 15-minute segment showing September 11 rescue workers
getting treatment in Cuba. The movie, scheduled for a U.S. release next
week, is aimed to be an exposé of the deficiencies of the U.S. healthcare
system and the Cuba segment indicates that the Caribbean island has better
healthcare than the United States.
Latin Business Chronicle asked several Cuba experts for their opinion on how
good the Cuban healthcare system is and how it compares with the U.S.
healthcare system.
"After many years of increasing disrepair, the Cuban health system is now in
crisis," says Jorge Salazar-Carrillo, a professor of economics at Florida
International University and expert on Latin American economies.
In reality, Cuba has three types of health systems, argues Jaime Suchlicki,
the director of the Institute for Cuban and Cuban-American Studies at the
University of Miami and a leading expert on Cuba. One for the Cuban
military, members of the Communist Party and leaders of the government. A
second one is for foreigners who pay in dollars or foreign currency and a
third one for the general Cuban population.
"The first two are excellent, with modern equipment and availability of
medications," he says. "The third, which is for the majority of the Cubans,
is a veritable disaster with poor equipment and few medications and in many
instances without the availability of Cuban specialists."
Salazar-Carrillo agrees. While Cuba has a high ratio of family doctors per
inhabitant, the actual offer for ordinary Cubans is low. About half of the
doctors are being exported to the poor countries of the world for hard
currency (mainly Venezuela), while a similar portion is at the service of
the Cuban Armed Forces and their families, he says. "Thus, at present the
real availability to the populace is meager," says Salazar-Carrillo. "Cuba
does not train the standard proportion of specialists."
However, Cuba does rank well in international surveys on mortality, maternal
mortality, and life expectancy, points out Eliseo J. Pérez-Stable, a
professor of medicine at the University of California at San Francisco.
"Cuba ranks near the top on all these parameters in all of Latin America and
I believe similar to the U.S. or just below," he says. "These are results
obtained by addressing the basic public health issues of infectious disease
control, basic nutrition and care for the high risk infants."
Nevertheless, even the official statistics are showing a worrisome trend.
"For many years now, Cuba has been reported in the international health
statistics as deficient in proteins and calories, even using the mendacious
Cuban statistics," Salazar-Carrillo says.
This should not be surprising since milk is only distributed in Cuba to
children under seven, those infirm, or over 65, he points out. "In the last
decade and a half there have been several epidemics and the island is on the
watch list of infectious disease specialists," Salazar-Carrillo says.
MEDICINE SHORTAGE
Although Cuba markets itself as an advanced medical treatment center for
foreign patients, it struggles to provide basic medicines to its own
population, experts say."Medications are difficult to obtain in
Cuba,Suchlicki says. "And [it] is not because of the U.S. embargo which
excludes medicine."
The main reason is that the Cuban government spends money primarily on its
own elite and foreign health patients, he says.
Salazar-Carrillo estimates Cuba receives $300-400 million a year in
humanitarian aid from the United States in the form of medicines and medical
devices. Despite that, there is a serious shortage for the Cuban population,
he says. "Medicine [is] very unavailable in Cuba, especially the most simple
medicines which to take care of every day problems, like aspirin, band-aids
and syringes," he says. "The doctors are always having to prescribe
alternative medicine because the ones they would like is not available."
Pérez-Stable believes the U.S. embargo does play a factor in the lack of
medicines. "The pharmaceutical industry is global and many products are not
sold to Cuba either because of the economic embargo or because Cuba will not
pay the high prices," he says.
To compensate, the Cubans have tried to develop their own home industry as
well as promote the generics and non-patent use industry prevalent in Brazil
and India, Pérez-Stable says. And management of many chronic diseases with
new drugs has expanded tremendously in the last 20 years, he adds. "Cuba has
not kept up because of the economic limitations," he says. "The absence of
a market also complicates the issue by shutting out any options."
CUBA BETTER THAN USA?
So, is Cuba's healthcare system better than the United States, as is implied
in Sicko? "Are you kidding?" says Salazar-Carrillo. "The U.S. is considered
the best healthcare system in the world and Cuba ranks among the lowest or
worst." Suchlicki concurs. The Cuban system is not better, but it's free, he
says.
"Although there is universal access to care in Cuba and some selected
aspects of the health care system may at times compare favorably with the
U.S., I don't believe anyone would say with any degree of believability that
it is "better" than the US," says Pérez-Stable. "This would especially
apply in the persons with chronic diseases such as diabetes, heart failure
or any form of cancer. "
The Cuban health care system may be very "cost efficient" in that the
favorable outcomes are obtained at a relatively modest investment, while the
U.S. system is known for being the most expensive, yet having inferior
outcomes to many developed European countries and Japan, he says.
However, there are areas where Cuba has not done as well as one may have
expected, Pérez-Stable argues. "Cervical cancer rates remain two to three
times that in the U.S. when access to Pap smears and treatment should have
led to similarly low rates," he says. "Cuba is also experiencing the biggest
lung cancer epidemic in the Americas outside the U.S. and Canada and this
may have been preventable 20 years ago with a concerted effort to control
tobacco smoking."
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